Provider Demographics
NPI:1093889651
Name:FAITHFUL SERVANT HOME CARE SERVICES
Entity Type:Organization
Organization Name:FAITHFUL SERVANT HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JERMILLS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-726-5786
Mailing Address - Street 1:4801 E. INDEPENDENCE BLVD. SUITE 1000
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5490
Mailing Address - Country:US
Mailing Address - Phone:704-726-5486
Mailing Address - Fax:704-259-9002
Practice Address - Street 1:4801 E. INDEPENDENCE BLVD. SUITE 1000
Practice Address - Street 2:SUITE 1000
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-5490
Practice Address - Country:US
Practice Address - Phone:704-726-5486
Practice Address - Fax:704-259-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3267251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health